African Americans experience the highest rates of stroke of all race/ethnic groups In the US. Stroke in African American occurs at younger ages than Caucasians. While racial disparities in stroke exist at all ages, disparities are greatest in young adulthood. Temporal trend data suggest that these stroke disparities in young adulthood may be widening. Hypertension is the most common and potent risk factor for stroke in the US. Blood pressure (BP) control rates are known to differ by race and may be an important contributor to racial disparities in stroke. Disparities in blood pressure control are most prominent in younger adulthood, further contributing to disparities in stroke rates in this age group. Efforts aimed at the primary prevention of stroke have generally not focused on young adulthood, despite the greatest disparities in incident disease being observed in this period and the opportunity for long-term risk reduction via interventions targeted early in adulthood. Effective intervention targeting known stroke risk factors (e.g. hypertension) have not been developed for young adults. Additionally the literature on novel risk factors present in young adulthood that may be amenable to additional risk reduction is currently lacking. DIADS is collaboration between Kaiser Permanente Northern California (KPNC) and the University of California, San Francisco (UCSF). DIADS seeks to design, implement, and evaluate a clinically-delivered hypertension control intervention that consists of both a clinical algorithm for rapid an effective blood BP control, as well as a culturally-tailored dietary Intervention aimed at more effective sustained BP control. Specific Aim 1: To conduct a cluster pragmatic randomized trial of a clinically-delivered hypertension control intervention (Shake, Rattle, and Roll) that will consist of a clinical algorithm for rapid and sustained blood pressure control, as well as a culturally tailored dietary intervention. Specific Aim 2: To conduct an observational cohort study of children, adolescents, and young adults within KPNC to identify temporal trends in traditional risk factors for stroke in the young, as well as novel factors that may Increase stroke risk in thi age group. Specific Aim 3: To implement the essential components of the Shake, Rattle, and Roll hypertension control intervention in a local community clinic serving a diverse population and then disseminate the intervention among a broad coalition of community clinics in Alameda County and San Francisco County. PUBLIC HEALTH RELEVANCE: Blood pressure control rates are known to differ by race and are likely be an important contributor to racial disparities in stroke, particularly for young Afrian American adults in whom a disturbing increase in stroke rates has occurred in recent years. The DIADS program will provide information that is likely to result in better understanding of stroke etiology in the young and a hypertension (HTN) treatment program that can reduce HTN control disparities and be disseminated widely, resulting in reduction of stroke disparities.